Provider Demographics
NPI:1588663249
Name:VAUGHT, STEPHEN K (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:K
Last Name:VAUGHT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 RING RD
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-9497
Mailing Address - Country:US
Mailing Address - Phone:270-769-5551
Mailing Address - Fax:270-765-3919
Practice Address - Street 1:1700 RING RD
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-9497
Practice Address - Country:US
Practice Address - Phone:270-769-5551
Practice Address - Fax:270-765-3919
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY16316208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1048767OtherPASSPORT
KY50030632OtherPASSPORT HMH
KY000000045854OtherANTHEM BCBS
KY020009361OtherRAILROAD MEDICARE
KY000000687760OtherANTHEM BCBS HMH
KY64163165Medicaid
KYP400031657Medicare PIN
KY000000045854OtherANTHEM BCBS
KY000000687760OtherANTHEM BCBS HMH